Participants Name
Grade
School BridgePrep AcademyClay CharterWOW MontessoriDuval SouthSideDuval WestSideDuval Flagler CenterDuval Scholars AcademyDuval MandarinDuval CoastalCollier CharterGuide PostHoop Dreams TravelNaples Adventist Christian SchoolSix Mile CharterOak Creek CharterThree OaksGateway CharterCape CoralBonita Springs Charter
Address
City
State
Zip Code
Name of parent(s) or guardian(s)
Home Number
Mobile Number
Email Address
RELEASE WAIVER AND CONSENT
Has my permission to participate in the Hoop Dreams North Miami basketball program. I certify that my child is fully capable of participating in the designated sport and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities. I understand that there are certain risks of injury inherent in the practice and play of this sport as well as in traveling and in other related activities incidental to my child’s participation, and I am willing to assume these risks on behalf of my child. I give my consent for all emergency medical care undertaken by a coach, volunteer, or prescribed by a physician or other healthcare provider for the player identified above. Care may be given under conditions necessary to preserve the life, limb, or wellbeing of the player. I waive & release any rights and claims I may have against Hoop Dreams North Miami & all members of the sports program. Further on my behalf and behalf of the player, and on behalf of all respected heirs, representatives, volunteers, coaches, directors, managers, administrators, and staff RELEASE, WAIVE, HOLD HARMLESS, INDEMNIFY, AND COVENANT NOT TO SUE HOOP DREAMS NORTH MIAMI.
PAYMENT AGREEMENT This Agreement between Customer and Hoop Dreams Ball INC. shall remain in effect until terminated, by either party for any reason, upon 15 days notice. TERMINATION NOTICE MUST BE IN WRITING and (in the case of Customer’s Notice), emailed to HoopDreams.CoachAJ@GMAIL.com. Upon receipt of written termination, Hoop Dreams Ball INC. will e-mail an acknowledgment of termination (“the Acknowledgment”) to the e-mail address listed on the termination notice. Termination shall not be in effect without the Acknowledgment and therefore Customer must retain a copy of the Acknowledgment in its records. Customer’s failure to terminate upon 15 days written notice will result in a charge for the full succeeding month. Termination of the automated payment plan does not automatically terminate your subscription, which stands independent of this agreement. I authorize Hoop Dreams Ball INC. to automatically charge my designated credit card account or authorize my bank to debit my bank account, as appropriate, by the 15th of every month on a recurring basis, starting no earlier than the date listed above, for the amount equal to my subscription. All changes and updates to the payment method may require a new authorization form. Refunds will not be permitted. If Hoop Dreams Ball INC. is unable to process my payment, I will be responsible for any alternate payment arrangement and any late fee which results. I understand that this Agreement may be immediately canceled by Hoop Dreams Ball INC. without notice, due to the failure of payment method. Hoop Dreams Ball INC. reserves the right to automatically retry up to three (3) times if the original charge/debit is unsuccessful rates. By signing this authorization, I acknowledge that I have read and agree to all of the above. All information given is complete and accurate. I represent and warrant I am authorized to execute this payment authorization for the purpose of implementing this Agreement. I indemnify and hold Hoop Dreams Ball INC. and the bank harmless from damage, loss, or claim resulting from all authorized actions hereunder.
I HAVE READ AND AGREE TO THE RELEASE, WAIVER, & CONSENT AND THE PAYMENT AGREEMENT.
Signature of parent or guardian
Date
305-345-5410
info@hoopdreams.com
